Cutaneous Disease as a Rare Presentation of Follicular Lymphoma Progression

Abstract

Follicular lymphoma, the third most common lymphoid malignancy, is considered indolent but incurable non-Hodgkin lymphoma. Isolated cutaneous relapse from follicular lymphoma is very uncommon, and very few cases have been reported in the literature. In this article, we present a case of an adult patient with a history of treated follicular lymphoma who presented with a skin lesion on his face and scalp. Further workup, including biopsy, led to the diagnosis of relapsed follicular lymphoma with no progression of disease elsewhere. We reviewed cases of follicular lymphoma, which relapsed with isolated cutaneous involvement. Treatment options for relapsed follicular lymphoma include observation, anti-CD 20 antibody alone, or in combination with chemotherapy, radio-immunotherapy, and stem cell transplantation in selected patients. Increased awareness of disease evolution and prompt diagnosis of this form of relapse from follicular lymphoma will improve the effectiveness and outcome of its management.

Skin lesions as the first manifestation of follicular lymphoma

“…Another fact to note is that in the described case the history of skin involvement from the first lesion to the condition presented lasted only 6 months and this was the first sign of the underlying disease. Various scenarios can be found in literature, ranging from rapidly growing tumours to slowly progressing ones [18].…”

“…Kolejnym faktem, na który należy zwrócić uwagę, jest to, że u przedstawionej pacjentki czas trwania choroby od pierwszej zmiany do prezentowanego stanu wynosił zaledwie 6 miesięcy i był to pierwszy objaw choroby zasadniczej. W piśmiennictwie można znaleźć różne scenariusze -od szybko rosnących guzów do powoli postępujących [18].…”

In Situ Follicular B-Cell Neoplasm Presenting as Miliary Facial Papules: A Unique Clinical Presentation and Spontaneous Regression

“…Cutaneous relapse from follicular lymphoma is uncommon, with few reported cases. 2 In situ follicular B-cell neoplasm (ISFN) is characterized by the proliferation of clonal B-cell populations confined within germinal centers, often discovered incidentally in lymph nodes exhibiting reactive follicular hyperplasia. In the 2017 WHO classification, ISFN was maintained as a variant of follicular lymphoma as "In situ follicular neoplasm" 3 ; while current revised 2022 WHO classification has refined this term as "In situ follicular B-cell neoplasm."…”